Transitioning to digital excellence

Foreword

by Una Harrington

The transition to Digital Hospital is currently being rolled out across Australian Emergency Departments. Our North Americans colleagues have been discussing for some time how the transition to Digital Care can cause frustration, loss of control and may possibly be a contributing factor in Physician Burnout.

We cannot be like ostriches with our heads in the sand about this topic. This transition will most likely affect us all in our different ED’s – particularly over the next 12 months in South East Queensland.

As a part one to a two part series on the transition to Digital, I asked my good friend and colleague, Alex Kochi, to tell us about his experience and lessons learned in Cairns Hospital.

My ED is due to transition in 6 weeks time. Later in the year, I will write about what our experience has been and what lessons I learned through the process.

Over to you Alex……..

Dr Alexander Kochi – Emergency Physican

DEM’s Diabolical Digital Dilemma of the Decade

A journey from chaos to mastery in the brave new world of the EMR

Ah the EMR! Friends and colleagues, say goodbye to your fancy fountain pens and to squinting at the barely-decipherable yet finely-honed penmanship of the medical registrar’s six-page admission.

Perhaps you have already said ‘goodbye’ and have moved on to writing your notes in EDIS. O, EDIS, how I love to gaze at your nicely ordered list of patients waiting to be seen. How you glare back at me with that nasty red dot of condemnation because I have let these patients wait too long. There is a rhythm to our work-dance and EDIS has long been our trusted partner. Always ready, with a hit of the F4 key, to refresh and ‘show us the damage’ after we surface from a thirty minute IV that should have taken us five.

But for many, it is time to say ‘goodbye’ to this old friend also.

Enter ieMR; it’s time to say ‘hello’ to FirstNET.

Unless you have been living under rock, surrounded by a Faraday cage, you would have likely heard of ieMR, FirstNET and ‘Cerner’. Queensland Health has embarked on a $1.2 billion IT strategy over 20 years which includes $730 million on rolling out the clinical software above. Unfortunately, the electronic spine of our health system had long been diagnosed with metastatic disease and was in need of some serious work: the fentanyl patches were just not cutting it anymore.

So in November 2015 Princess Alexandra Hospital turned off the ventilator for EDIS and went ‘live’ with FirstNET followed closely by Cairns Hospital in March 2016. In Cairns, this occurred on a Saturday and I worked the following week; forearmed (and forewarned) by a four-hour FirstNET tutorial.

You know that scene in Jurassic Park when the power goes out and everyone slowly realises that the T-Rex and Raptors are loose? It was similar, but without the feeble attempts at reassurance by Sir Richard Attenborough.

I distinctly remember feeling out of control.

I felt I was constantly battling for ‘control’ of the floor – it wasn’t that anything about the day had changed. Nor had the work, really. It was the realisation that my long-trusted partner had changed. The information was all there – I just had a lot of trouble processing it.

How many patients, where they were, what they had presented with, what category they were given, how long they had been present, who had been seen, who had been referred and when, whether those referred patients had been seen, who was admitted, who was awaiting a ward bed?… That’s a lot of information that we were previously used to taking in at a glance.

It was all still there, understanding it just took more mental energy, more cognitive bandwidth, and more time – all precious and limited commodities for FACEMs working ‘on the floor’. I felt like Jim Lovell (Apollo 13 Commander) when he incredulously stated to his boss, after being informed their Command Module Pilot needed to be changed three days before launch: “You want to break up my crew … when we can predict each other’s moves, we can read the tone of each other’s voices?!”. My partner in this job had changed, and I had to deal with it.

I initially thought it was just me.

Now, I’m a proud Gen-Y ‘Millennial’. I’ve been a gamer (read: video game master) since I was about four years old, and know my way around most computer software almost instinctively. Nevertheless, I found myself at one point, holding the small tubes of blood that I had just taken from a screaming 18 month old (which should have been the hard bit), staring at the computer screen thinking: “Now what do I do?”.

“Alex, you are completely incompetent!” came my inner voice.

Take 2.

Nurse: “Alex, can you please check the ECG for bed 9?”

Me: “Sure…” – I can do that! “Where is it?” – Holds out hand, expectantly…

Nurse: “Oh, I’ve transferred it to FirstNET. He’s come in with some dizziness… Just sign it off ok?”

Me: “….. uh …..”

“Told you… incompetent… can’t even sign off an ECG”

Rinse and repeat. For obs. For BSL. For urine beta-HCG. For urine dipstick results.

How do I refer this patient? How do I move this patient on the screen?

How do I even discharge someone from this place?!

Sigh… Maybe it’s because I have only been a consultant for six months? The others seem okay.

The day eventually ended. I went home feeling exhausted, frustrated and migrainous (bilious even).

I soon learned that the whole complex machine that is our hospital was suffering similarly. It wasn’t just me. And it certainly wasn’t because I was new. In fact, some of the older FACEMs were feeling worse (if that was possible).

Two years on, I think there are some useful lessons I would like to share:

It’s ‘okay’ to grieve the change BUT don’t refuse to change.

Expect to go through the Kubler-Ross five stages of grief: denial, anger, bargaining, depression, acceptance.

Allow yourself the time to adapt AND reassure yourself that you still know how to do the job

Talk with others about the difficulties you are all facing – BUT don’t plan a coup to bring down the ieMR and re-instate EDIS (not saying I did that at all…).

Support each other ESPECIALLY those who are less technologically adept. Share your tips, tricks and shortcuts with each other and utilise the expertise of the digital hospital trainers.

Yes it’s hard now, BUT you will get quicker and more efficient with time.

Remember, despite the vast amounts of time you feel you are spending with ‘machines’, the human interactions are what really matter in this job.

There is light at the end of the tunnel, and it’s not the red reflex of a velociraptor! Like the introduction of any new process, it takes practice and patience for perfection.

There was a hit to our system performance, no doubt. Personally, it took me about two months to become about as efficient with FirstNET as I was with EDIS. It took another two months and some tinkering by our department before I became quicker with FirstNET than EDIS. Now, I would choose FirstNET over EDIS and am more efficient in my day to day work because of the change.

Don’t underestimate your capacity to grow and change. As humans it is uncomfortable and we don’t particularly like it, but as FACEMs – you are probably better at it than you realise!